Process in which a health care professional evaluates an attending physician's request for a patient's admission to a hospital by using established medical criteria.
an authorization for hospital admission given by a health care provider to a group member prior to their hospitalization. Failure to obtain a preadmission certification in non-emergency situations reduces or eliminates the health care provider's obligation to pay for services rendered.
An element of utilization review, which examines the need for proposed inpatient service(s) before admission to an institution to determine the appropriateness of the setting, procedure, and length of stay. Preadmission certification seeks to ensure that providers do not hospitalize people unnecessarily or for longer than is medically necessary.